Healthcare Provider Details

I. General information

NPI: 1871076539
Provider Name (Legal Business Name): PATRICK SCOTT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 WILSHIRE AVE NE
ALBUQUERQUE NM
87122-2807
US

IV. Provider business mailing address

PO BOX 25704
ALBUQUERQUE NM
87125-0704
US

V. Phone/Fax

Practice location:
  • Phone: 505-823-2327
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberC-08522
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: